Surgery is the practice of direct manual
manipulation of an injury usually involving cutting open the body or entering
an already open wound. This is differentiated from other practices such as
medicine, herbalism, spiritualism or even magical healing. However these
various healing disciplines may play a role in the surgical process.

Standard Procedures.
Surgery has historically been the domain of the
human and elven races in
Santharia. The primary need arose on the
battlefield as injuries occurred. There was a time when even the most minor
injury resulted in a permanent disability or death. Over time the
humans and elves
learned that by intervening the injury could be managed or even fully
corrected. The other main races of Sarvonia
have not advanced as far as humans and
elves in the practice of surgery for various
reasons. Dwarves have advanced in
some of the more barbaric surgical procedures described here; however the
delicate surgeries requiring finesse and patience seem to go unpracticed by
most dwarven tribes.
Orcs have not advanced far in surgery for an
entirely different reason. Surgery requires that one person helps another
person to be healed. In general when an orc becomes injured the other tribe
members view this as a weakness and will let the orc die. In some rare cases a
particularly brave orc will attempt a makeshift
surgery on his own body, however the effects of pain, blood loss and infection
usually take over.

In the author's travelers throughout Sarvonia
he has seen many varying surgical procedures. Kelancey the Green has this to
say:

“I have been truly
amazed by the ingenuity of the advancements in the practice of surgery as
well as disgusted by the barbarism I have seen. Unfortunately it seems
that most tribes throughout Sarvonia
practice more of what I would call elementary surgery with only the larger
populated areas like New-Santhala
practicing the advanced techniques. My hope is that through the
Compendium healers all
over Sarvonia will learn the advanced
techniques and that these practices will become more commonplace in the
remote areas of our lands, thereby saving many lives.”

The following are the various surgical
procedures witnessed in the travels of Kelancey the Green:

Brain Exposure
("Trepanning", "Skull Drilling")
Trepanning is a barbaric surgical procedure performed by some human tribes in
Northern Sarvonia. This procedure
is usually performed when a patient complains of chronic or migraine brain
pain. Usually before the brain exposure procedure is performed the patient has
already tried a number of other less intrusive measures, with no result,
leaving them desperate and sometimes crazed. The procedure is performed using a
tool called a treppan. The treppan is a two-handed twist screw. One model is
shaped like a straight rod with two handles. A second fashion is a rod, about a
fore in length, bent at
right angles in four places, shaped like a straight-brimmed hat: One "brim" is
the handle which remains steady, and the instrument rotates inside this handle.
The "dome" of the hat is a second handle, which is spun around in a circle, and
it is this handle which turns the screw. The other "brim" of the hat ends in a
drill or countersink screw. With one handle being used to steady the
instrument, the treppan bores a hole and removes a circular disc from the
skull. For some patients this procedure relieves the pain. The ice tribes claim
the procedure releases the inner demons while others believe the brain’s
exposure to air heals the pain. However, in most cases the patient suffers
infection and dies. In fact, the rates of survival are so low that the more
advance tribes in the north and those in southern
Sarvonia have outlawed the practice. At
this time we are only aware of humans in the
north performing this procedure.

Blood Cleansing
Blood cleansing is the withdrawal of blood from a patient’s body in an effort
to remove the so-called “dirty” blood. Blood can become dirty in a number of
ways such as disease, infection, curses and demonic possession. In fact some of
the more barbaric tribes prescribe blood cleansing for the vast majority of
diseases and illnesses. The idea behind the practice originates from the common
understanding that blood contains the person’s life force. When the blood
becomes contaminated it is necessary to remove that contamination or else the
patient will die. Unlike contaminated water which is removed through the urine
or contaminated air which is ejected by exhaling, contaminated blood must be
removed by a healer.

A number of different methods are employed to remove blood from the body. The
most common and crude method is to simply puncture the patient in a high
blood-flow area such as the neck, wrist or groin. If done correctly the dirty
blood will escape the body in a rapid fashion. Another method used is the hot
cup method. A cup containing hot air is
pressed against a wound. The heat draws the dirty blood from the wound and is
conveniently caught by the cup. Leeches are also used by some healers.

In all these cases the typical practice is to continue drawing blood until the
patient faints. This is the general indication that the contamination has left
the body.

While the practice of blood cleansing is generally used to heal patients of
illness and disease, there have been reports of the practice being used to cure
curses and demonic possession. Furthermore Kelancey the Green obtained this
report from a local healer in one of the remote
Ice Tribes in
Northern Sarvonia.

“Ahh yes. Just last year I attempted to
clean the blood of a young man visiting us from the south. He wore a strange
robe with runes and markings and carried a skinny staff. He was ill suited to
survive in our lands as his robe was not thick enough to keep out the cold and
his staff was not strong enough to kill even a small rodent for food. However
when it came time to sleep our men noticed he was able to start his cooking
fire with nothing but his fingers. the young man was quickly seized and brought
to me for surely he was contaminated with magic.
We attempted to rid his body of the magic, but
it had taken a strong hold on him. His screams and protestations attested to
the extent of the infection. Unfortunately the
magic was too strong and he died before he had the chance to faint.”

Amputation
During wartime the wounds received, however minor, usually result in infection.
Some of the less advanced tribes attribute this infection to the supposed evil
present in their enemy’s blades. More advance healers simply recognize that a
warblade and the conditions on a battlefield lead to dirty and infected wounds.
Amputation is the removal of a limb in order to stave off the spread of
infection or poison, thus protecting the core body. Amputation is a rather
common procedure performed during wartime and to a lesser extent during
peacetime. Common procedures include the removal of a finger, forearm, or
entire arm, likewise toes, lower leg or full leg. For certain the larger the
body part amputated the more risky the procedure. The amputation procedure
includes the careful cutting of the skin and muscle with a clean
sword, knife or dagger followed by using a
sawlike blade to cut through the bone. Success with this procedure largely
depends on how effectively blood-loss and infection are managed. For certain
the patient’s pain is also managed and during wartime this is usually
accomplished through the consumption of alcoholic drink. Finally the remaining
stump is bandaged and the patient is monitored.

While speaking to an Erpheronian
general about war wounds, an interesting observation was recorded regarding
dwarven amputation. “We were in the heat of battle and I was beside a company
of dwarves. One of the
dwarven warriors was cruelly hit by a war
mace crushing the bones in his left forearm. Without hesitation the
dwarf laid his arm across a nearby boulder
and his companion used his axe to hack off the limb near the elbow. The
resulting wound was quickly bandaged and the
dwarf returned to the battle immediately. I am not aware if he survived the
battle.” This story corresponds to other rumors concerning the
dwarven miraculous resistance to the pain of
an amputation and their persistence on the battlefield.

Santhalian Section
("Infant Extraction")New-Santhala has boomed in population
over the past 100 years. While there are many causes, one is for certain, the
increasing use of the Santhalian Section procedure, a groundbreaking procedure
that has saved the lives of countless mothers and babies during childbirth. The
procedure is quite simple. In the event that complications during pregnancy
make natural childbirth impossible the surgeon will simply cut into the
mother’s abdomen using a small sharp blade, sometimes referred to as a scalper
or scalpel, and extract the baby manually. Regardless of the simplicity of the
procedure, highly advanced knowledge of the female anatomy is necessary to
avoid killing the unborn baby and the mother. To date only the healers in and
around New-Santhala have been able to
perfect the procedure giving birth to the name Santhalian Section.

Extraction of Teeth
Rotten teeth often wait for the most inopportune time to fester and
incapacitate the bearer of bad teeth. Of course, the instrument of choice would
be the barber's pincers, aided by a course of miyu beans to dull the pain. In
less optimal circumstances, bowstrings and garotte cords have seen use in
yanking teeth. A different approach would be to use a tanner's awl or a
quarryman's chisel, along with a cook's wooden mallet, to "gently persuade" the
tooth to come out.

Eye Surgery
While a very dangerous and rather unknown procedure, eye surgery has been
attempted and succeeded, leading to at least moderate vision improvement on the
subjects. The surgeon will push a long and very thin needle through the outer
part of the eye to break up any 'blockages' and the remaining pieces are gently
sucked up using an equally long and thin tube. Since this practice is rather
dangerous and requires an expert’s skill, it is difficult to find surgeons
willing to perform this outside of
New-Santhala. Tere have been rumours of attempts by Northern healers, but
whether the surgery was a success, or more importantly, if the patient lived,
have remained so far, unconfirmed.

Blood Insertion
This procedure is the converse of the blood cleansing procedure. The idea is to
somehow insert the healthy blood from an external host into the body of the
patient thus revitalizing the patient with clean blood and health. The problem
arises with finding a successful way to get the blood into the body. Quickly it
was discovered that drinking the clean blood was not effectual. Early
experiments attempted to pour the clean blood into the patients body through a
small incision in the patients abdomen. Other experiments attempted to push the
blood into the arm or neck by squeezing a leather bag full of clean blood
through a glass tube and into the body. To date no blood insertion surgery has
been a success, however gnomes are working on designing new glass tools that may
enable a more precise insertion of blood. Healers we have spoken to are certain
once the correct tool is designed the surgery will be a huge success with one
healer quoted as saying "Imagine the possibilities. We have an abundance of
clean blood all around us in our cattle, swine and sheep which goes to waste
each time we slaughter our animals for food. Once we can figure out how to
insert this clean blood into our patients we can cure all kinds of diseases and
illnesses and save lives. The results will be revolutionary!"

Organ Removal
Normally when a patient complains of pains within the core of the body the
healer will administer normal pain management procedures. If the pain persists
the healer may conduct the blood cleansing procedure. However we have evidence
that some more radical healers have been attempting to cut open the body and
remove the organ causing the pain in hopes the problem would be cured.
Miraculously some patients have survived the initial surgery however almost in
all these cases the patient has died from the loss of the organ. There have been
reports that certain organs have been removed without causing immediate death.
One such organ is located in the lower abdomen subsequenlty named the "appending
organ" or "useless organ". Another successful case was the result of removing
one of two organs in the lower back. The assumption is the redundant organ was
not needed. However this is only the case with the redundant organs of the lower
back, the redundant breathing organs of the upper chest are apparantly both
necessary to the survival of the patient.

Reattachment Procedure
The vast number of amputations that occur especially during war time has led to
experiments of reattachment. In this procedure the patient's amputated limb or
limb from another host is attached to the patient in hopes the limb will become
alive and function. Reports of this new experimentation initially led to many
hundreds of volunteers. To date only early experiments with this procedures have
been conducted with no success. In every case the attached limb is immobile and
unfeeling. Within hours the limb begins to putrify and stink. In days the limb
becomes fully black and bloated. In some cases the limb becomes "sick" in which
the sickness spreads to the patient causing death. The news of the horrors seen
in these early experiments has spread and now almost all reattachment
experiments are performed on war prisoners and criminals.

Further report have been heard of the reattachment surgery being taken to
further extremes. Rumours exist that experimentation with cross race attachments
are being conducted with no success. One rumour even suggested that experiments
on dead corpses were being conducted wherin the "best" parts of each race were
attached to a dead human host in an effort to create the perfect race.
Apparantly student mages were attempting to reanimate the corpse when officials
from the Ximax academy stepped in and ended
the affair.

Closing Wounds.
Surgical wounds are closed in generally the same manner as the various types of
cuts and wounds. Examples include the following:

Blue
Myrmex Stitches
It is well-known that the wild tribes of
Nybelmar and Aeruillin commonly use the
stone myrmex to seal small cuts, drawing the edges of the wound together and
then placing the insect’s head along the incision, whereupon the beast spits its
defensive material, which hardens upon exposure to
air. A single myrmex can seal about a
thumbnail’s width of cut
before its supply becomes exhausted (indicated by an unwillingness to bite and a
lax, drooping abdomen), and another insect must be chosen. The sealed cut
resists infection, and the ‘stitches’ will hold up well under perspiration and
water. The stitches should be renewed each
day, as this lessens the risk of the wound becoming infected as the heads decay.
It is recommended that this method is only used in extreme emergencies, as the
numbing effect of the myrmex venom could
cause permanent disabling if used in excessive amounts.

Silkel
Tree Thread Stitches
The silkel tree, also called the
Ilárol’pherán ("Silver Tree") or Cáo fá Eú'reóll, ("Child of the Tree of Life"),
in Styrásh, is regarded as one of
the most beautiful trees in all of Caelereth,
and many believe it to be touched by a kind of immortal
magic. Either its enchanting appearance, or
perhaps its amazing healing powers, or maybe its inclination to grow in places
touched by myth and wonder, lead to the belief that it’s a tree closer to
ethereality than to corporeality. This sheeny tree has a number of uses, many of
them of medicinal purpose. The tree is mostly known for its thread-like bark
that can be made into silk. The silk is used as stitching/suturing thread. Using
a large strand of silk, the healer will double stitch the wound. This is done as
a precaution, for the silkel thread might break. Then bandages are added and
wrapped tightly. Silkel trees are rare, found in forests all throughout
Caelereth, especially
Thaelon,
Bolder,
Quallian,
Zeiphyrian,
Sharadon Forest,
Auturian Woods,
Shaded Forest, and others.